There is sex. And there is safer sex. Depending on the situation, it can be difficult for a woman to have safer sex.
Why? Her reality might include:
- a strong belief that HIV, AIDS and sexually transmitted infections only affect a certain group of people – a group she doesn’t belong to
- growing up without access to sexual health information – or with ideas that sex is taboo, women are men-pleasers and that they should only be concerned about bearing children
- fear of being rejected by a loved one if she uses a condom
- a deep trust of her partner, with whom she has been faithful – such a relationship can make it hard to bring up safer sex, or to ask about getting tested
- an abusive relationship – whether it is physical, emotional, financial or a combination of those
- pressure to having paid sex with men, without protection, in exchange for more money
- a mental health issue that both gets in the way of understanding the importance of safer sex, and also makes it easier to talk her into having unprotected sex
HIV and sex
When it comes to sex, women’s greatest risk of getting infected is by having unprotected vaginal or anal sex with an HIV-positive person. Safer sex includes the use of a female or male condom. A female condom is one that a woman can insert inside her vagina (or anus) before sex, a male condom is one that is placed on a man’s erect penis.
During unprotected vaginal or anal sex, semen stays in contact with women’s tissues longer than a man is exposed to her secretions, and even microscopic tears in tissue can lead to HIV transmission. Young women and post menopausal women, who have less resilient vaginal tissues, are particularly vulnerable. Undiagnosed and untreated sexually transmitted infections can also increase the risk.1
Sharing sex toys is not considered as high risk as unprotected vaginal or anal intercourse. However, sharing toys such as vibrators, dildos or anal beads without thoroughly cleaning them in soap and hot water does carry a risk of HIV transmission.
Very rarely, women can also become infected through unprotected oral sex. This means not using a condom (when a man is being pleasured) or a dental dam (when a woman is being pleasured). There is a possibility that HIV in vaginal fluids or semen may get into the bloodstream through the mouth and throat.
According to Canadian law, if someone knows about being HIV positive, that person must tell his or her sexual partner(s). Otherwise, there could be serious legal trouble.
Sometimes, a woman is in a situation where this concern is at the bottom of a very long list of worries. It is not the major issue she feels she needs to deal with right away. She could be thinking about how she will cover the rent. Concerned about her children. Worried about violence at home. Or about her ability to stay in the country. Or about being alone.
That said, prevention, protection and education can help stop the spread of HIV, as well as the stigma surrounding it.
Safer sex practices include:
- openly talking to a partner about sexual needs and concerns
- discussing sexually transmitted infections and HIV with sexual partner(s)
- using protection while having sexual intercourse by wearing either female or male condoms
- using a dental dam (for cunnilingus and analingus) or a male condom (for fellatio)
- cleaning sex toys with hot water and soap for several minutes with each use
- sex partners each taking an HIV test
- discussing the type of relationship and commitment each partner wants – exclusive, open, long-term or casual, for example
- women using water-based lubrication (“lube”) to reduce the risk of infection through vaginal and anal tearing
- having condoms handy, even when sex isn’t planned
For a woman who is sexually active with men, the best way to avoid the spread of HIV is by using a condom. Since condoms are not always an option, it is important to know what the other choices are for safer sex.
- Our page, Sexual Health – why not condoms?, goes into more details about why women might not use them.
- Another page, Sexual Health – risk reduction, includes suggestions and sexual health information that can still help reduce the risk of HIV transmission.
Let’s talk about sex
Having somewhere to go to that is a non-judgemental, open environment can help open up the discussion. The place needs to be comfortable and confidential. It can be where a woman talks about safer sex, sexuality and HIV, the importance of touch, fears of being alone and whatever else might be on her mind about relationships and sex.
Such a supportive environment could be the first place she’s had the freedom to speak up about these parts of her life.
More from Shared Health Exchange
1What’s So Different for Women?, HIV, Community & Relationships,Positive Women’s Network, online as of June 2011